Brain Conditions 'Ideal' for Separating Twins, Doctors Say

By DENISE GRADY

Published: October 21, 2003

Eighteen-month-old Filipino twins joined at the head underwent the first in a series of operations yesterday expected to end with their separation several months from now at a hospital in the Bronx.

Doctors said the twins, Carl and Clarence Aguirre, were in good condition last night, slowly waking up from anesthesia in the pediatric intensive care unit at Children's Hospital at Montefiore with their mother, Arlene Aguirre, by their side. They are still fully conjoined and will not be separated until the third or fourth operation.

''They're already reacting to Mom, and moving all their extremities,'' Dr. David Staffenberg, one of their surgeons, said in a telephone interview. ''Carl gave me a wave and tried to swat Clarence on the head.''

The operation began at 9:20 a.m. and took about three hours, with a surgical team of about 20 people, including separate anesthesiology teams for each boy.

The purpose of the surgery was to let doctors open the front of the boys' joined skull to examine shared blood vessels and determine if their brains are fused, and to insert skin-expanding devices under their scalps so that when they are separated there will be enough scalp to cover two heads.

The expanders, pouches that are gradually inflated with salt water, will stay in place until the last operation. More expanders will be added in later operations, for a total of four to six, Dr. Staffenberg said.

Dr. Staffenberg said that when Dr. James Goodrich, the boys' neurosurgeon, opened the skull, what the doctors saw was ''absolutely ideal.'' The boys' brains seemed to have a natural division and were not stuck together, meaning that the surgeons should be able to separate them safely. Another important finding was that not many veins were shared at that location.

''We don't want to get ahead of ourselves, because we've got a long way to go,'' Dr. Staffenberg said. ''But absolutely, for this stage, it was as good as we could imagine it could be.''

The doctors expect to perform the operations about three weeks apart and to gradually reroute the circulation in the boys' heads so that shared veins can be assigned to one or the other. When the blood vessels are sorted out and the circulation is stable, the boys will be separated. More operations will be needed later to build up their skulls.

The boys, who were flown to New York from the Philippines on Sept. 10, have been spending most of their time at Blythedale Children's Hospital, a rehabilitation center in Valhalla. Dr. Staffenberg said they would probably return there by tomorrow or Thursday. They will stay at Blythedale to recover and to receive physical therapy after they are separated. Both hospitals are providing free care.